First Documented Long COVID Case Study Involving Impaired Secretion of Adrenocorticotropic Hormone Due To SARS-CoV-2 Infection

Long COVID: Unknown to many, SARS-CoV-2 infections can also cause a variety of disruptions or dysregulation of the endocrine system causing the impairment of various hormones critical for life sustenance. Some of the Long COVID symptom manifestations are actually due to impairment of certain hormone secretions.


 
In this documented case study, researchers from Division of Diabetes and Endocrinology at Hyogo Prefectural Kakogawa Medical Center-Japan, Kobe University Hospital-Japan and Kobe University Graduate School of Medicine-Japan presented details involving the 15-month clinical course for an individual with multiple endocrine disorders of the pituitary gland and testis likely triggered by COVID-19.
 
The patient…a 65-year-old man with no history of endocrinopathy was admitted for acute COVID-19 pneumonia. Although his respiratory condition improved after administration of antiviral drugs, his blood pressure dropped suddenly to a pre-shock level and was refractory to vasopressors.
 
It was found that the circulating adrenocorticotropic hormone (ACTH) and cortisol concentrations were low, and secondary adrenal insufficiency was suspected.
 
Subsequent administration of hydrocortisone rapidly ameliorated the hypotension, and the patient was discharged taking 15 mg of hydrocortisone daily. An insulin tolerance test performed 3 months later revealed impaired ACTH, cortisol, and growth hormone (GH) responses, indicative of combined hypopituitarism.
 
The patient also manifested symptoms of hypogonadism, and a hormonal workup suggested primary hypogonadism. At 12 months after discharge, GH and ACTH responses had recovered completely and partially, respectively. After another 3 months, basal ACTH and cortisol levels had been restored to the normal range and the patient discontinued hydrocortisone replacement without exacerbation of symptoms, although his hypogonadism persisted. The patient thus developed transient GH and ACTH deficiency that lasted for more than a year as well as persistent primary hypogonadism during intensive care for COVID-19. Certain prolonged symptoms of Long COVID might be accounted for by such hormonal disturbance.
 
The study case study was published in the peer reviewed Endocrine Journal.
https://www.jstage.jst.go.jp/article/endocrj/advpub/0/advpub_EJ22-0108/_article
 
Long COVID is becoming a significant issue worldwide. It refers to a variety of symptoms that persist over an extended period after the patient has recovered from a novel coronavirus infection (COVID-19). In many cases, it is unclear what causes Long COVID symptoms, and there is insufficient information regarding recovery time.
 
One important issue is that Long COVID is not caused by merely a single factor but rather is due to a combined number of factors and there is no single drug or treatment protocol that can treat Long COVID. It has to be approached from a personalized medicine approach. Readers should be aware of many scammers online promoting single products for Long COVID or unproven and fake treatment protocols including using blood replacement therapies, zone treatments, ivermectin, bottled liquid phytochemical concoctions or garb age treatment protocols being promoted by the FLCCC.
 
This case study is the first to report a 15-month clinical documentation on a patient's recovery from impaired adrenocorticotropic hormone (ACTH) secretion brought on by novel coronavirus infection.
 
The study team included Professor Dr Ogawa Wataru and Assistant Professor Dr Yamamoto Masaaki (both of the Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine), and Dr Iida Kenji (Head of the Division of Diabetes and Endocrinology at Hyogo Prefectural Kakogawa Medical Center).
 
The case study provides an example of the recovery period for a hormone secretion disorder, one of the widely reported aftereffects of COVID-19. This information will hopefully help individuals whose quality of life (QoL) has declined due to Long COVID.
 
Accordingly, after the patient had recovered from respiratory failure, impairment occurred in a part of the brain called the hypothalamic-pituitary system, resulting in insufficient secretion of ACTH. This long-term case study shows the recovery process.
 
It should be noted that it is unclear what causes the aftereffects of novel coronavirus infection and it is not known how long they continue. Therefore, many individuals are suffering from decreased QoL even after recovering from a novel coronavirus infection.
 
This case study is important because it provides an example of a recovery treatment course for impaired secretion of pituitary hormones, which is one of the aftereffects of novel coronavirus infection.
 
The SARS-CoV-2 coronavirus can cause respiratory illness, in particular pneumonia. However, it has been reported that SARS-CoV-2 infection can also affect various other parts of the body beyond the respiratory system, including the heart and blood vessels, the digestive organs and liver, the nervous system, muscles and bones.
 
Past studies have reported that impairment of the endocrine organs (pituitary gland, thyroid, pancreas, adrenal glands, and testes) is accompanied by decreased hormone secretion.
 
https://www.thailandmedical.news/news/breaking-news-italian-study-reveals-that-sars-cov-2-is-able-to-affect-the-pituitary-gland-leading-to-possible-hypopituitarism-and-a-variety-of-disorde
 
https://www.thailandmedical.news/news/breaking-covid-19-endocrine-system-new-study-shows-that-sars-cov-2-damages-the-endocrine-system
 
https://www.thailandmedical.news/news/breaking-german-and-swiss-study-discovers-sars-cov-2-targets-and-causes-cellular-damage-to-adrenal-glands-resulting-in-a-variety-of-health-conditions
 
https://www.thailandmedical.news/news/italian-study-presented-at-endocrine-society-s-2021-annual-meeting-shows-that-sars-cov-2-causes-a-unique-thyroid-inflammation-in-some-patients-
 
https://www.thailandmedical.news/news/coronavirus-news-tiredness-and-fatigue-in-the-covid-19-era-could-be-due-to-addison-s-disease-as-sars-cov-2-also-attacks-the-adrenal-glands
 
https://www.thailandmedical.news/news/breaking-french-covid-19-research-reveals-that-the-hypothalamus-region-of-the-brain-is-also-a-target-for-the-sars-cov-2-coronavirus
 
https://www.thailandmedical.news/news/covid-19-latest-yet-another-study-showing-effects-of-sar-cov-2-on-the-thyroid-gland-including-thyrotoxicosis
 
https://www.thailandmedical.news/news/breaking-japanese-study-uncovers-that-sars-cov-2-impairs-the-insulin-growth-factor-igf-signaling-pathway-with-detrimental-health-implications
 
https://www.thailandmedical.news/news/breaking-cso-from-london-medical-laboratory-warns-that-thyroid-issues-escalating-rapidly-in-the-united-kingdom-could-be-due-to-omicron-or-previous-var
 
https://www.thailandmedical.news/news/study-reveals-sars-cov-2-binding-to-host-dpp4-receptors-causes-dysregulation-of-proteins-associated-with-diabetes,-leading-to-severe-covid
 
The issue of Long COVID is becoming a huge problem worldwide. In addition to respiratory issues, patients with Long COVID suffer from a variety of long-term symptoms (such as fatigue, low fevers and physical pain) even after recovering from the infection.
 
In this case study, after having symptoms such as fever and breathing difficulties for over one week, the subject took a PCR test, which came back positive. He was subsequently hospitalized for treatment but his breathing difficulties significantly worsened due to pneumonia and he had to be put on a respirator. Through treatment (including anti-viral medication) the patient gradually recovered from respiratory failure to the point where he could be taken off mechanical ventilation. However, 10 days or so after being taken off mechanical ventilation, his blood pressure suddenly dropped and the test results showed that ACTH secretion was severely impaired. Administration of ACTH rapidly restored the patient's blood pressure.
 
A thorough hormone test showed that hypothalamic-pituitary system impairment had caused a decrease in growth hormone secretions as well as ACTH. The patient was given ACTH replacement therapy, which ameliorated hormone secretion. After a year and a half, hormone levels had returned to normal and replacement therapy was no longer necessary.
 
To date, there have been many reports of endocrine organ impairment leading to decreased hormone secretion in patients during treatment for SARS-CoV-2 infection or post-infection. However, this is the first reported case study in the world to track the recovery process and follow up on a patient with this particular long COVID symptom.
 
Though many surveys are being conducted on Long COVID in countries all over the world, its pathology remains elusive. It is also not fully understood how long these symptoms persist.
 
Importantly in this case study, ACTH was one of the hormones with impaired secretion that was a key factor for Long COVID symptom manifestation. ACTH is normally secreted by the body in response increased physiological or psychological stress. However, the body is unable to fight effectively against stress when not enough of this hormone is secreted. If there is a high level of secretion impairment, this causes severe, life threating symptoms. On the other hand, slight impairment causes non-specific symptoms such as becoming tired easily, a lack of energy, and low mood.
 
It should be noted that adrenal insufficiency is easily overlooked in routine medical examinations.
 
Past research has reported that decreased ACTH secretion as an aftereffect of SARS-CoV-2 infection occurs at a frequency of between 16 to 39%, therefore this case study is not a rare example.
 
Importantly, many of the Long COVID symptoms resemble those of adrenal insufficiency; therefore, it is highly probable that among Long COVID individuals, the lighter symptoms of adrenal insufficiency are being overlooked.
 
To date, it is currently unclear how long the aftereffects of novel coronavirus infection typically last. There are currently individuals who are suffering from Long COVID with no clear end in sight. This case study, which shows the recovery process for one of the aftereffects, is especially significant for these people.
 
The study team next plans to work with hospitals nationwide across Japan to conduct surveys on hormone secretion levels in patients who are experiencing Long COVID symptoms.
 
For the latest Long COVID research, keep on logging to Thailand Medical News.